Medicare covers wheelchairs; you pay 20%

What is it like to have Medicare as your primary insurance, in particular for durable medical equipment, such as prostheses or wheelchairs?

Shifting Forward

Dear Shifting Forward,

Medicare Part B does cover durable medical equipment, including prostheses and wheelchairs.  See’s list.  “Part B” is Medicare’s coverage for physician services and other out-of-hospital items.  It is also the part that requires you to pay each month for the coverage.  If you are receiving Social Security retirement payments, they will deduct your Part B premiums from your check.  (In 2014, most people pay $104.90 per month.)

The other important thing about Part B is that it has a deductible and co-insurance.  This means that you pay a certain amount up front before the plan pays anything.  In 2014, the Part B deductible is $147.  The co-insurance means that you pay a percentage of the bill.  For medical equipment, you will pay 20% of the charges.  The charges are negotiated by Medicare.

Keep in mind that Medicare does not put a limit on how much you pay out of your own pocket.  The 20% of the wheelchair cost might be a few thousand dollars.  If you want to have a cap on your out-of-pocket expense for medical bills and you have Medicare, you need to get a “Medigap” or Medicare supplemental plan.  You need to get this plan soon after you start on Medicare; if you wait, insurers will charge you a penalty. The penalty will increase your monthly cost for the coverage.

Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.